After being told that you have cancer, removing the majority of the emotions for the time being [hence the black and white version], your initial reaction is to find out what is next. What happens now? What are our next steps? That first day went incredibly fast and we received a lot of information for just the beginning steps. I received a multitude of calls that day from the hospital in which I had my biopsies done, they were amazing through the whole process from beginning to end. During one of the calls they informed me that my first step was to meet with an oncology surgeon that would help me decide my treatment plan. However, during this call they also informed me that I had options to move my care and that since I worked so close to University of Colorado Health (UCH) at Anschutz Medical Campus, I may want to consider working with them. UCH had a lot of experience in the cancer world, not that my other facility didn’t, but UCH specialized in cancer found in younger populations and had some of the best providers for breast cancer found in young women. Another consideration was that it was closer to my home (in some respects) and it was also super close to my work which would make some treatment days and doctor appointments very convenient. Plus, since I worked in a lab that often worked closely with UCH I knew their reputation well and I felt it was the best option for me to make the move to UCH; and so I did.
Keep in mind that everything I am telling you here in this entry is still taking place within the first day of being diagnosed, even in the first eight hours of knowing that I had cancer. There will be a version of this story that handles the gray matter where I talk a little more about the emotions you go through, but for now, we are sticking with facts and the process.
I contacted UCH and informed them of my situation and let them know that I would like to have them handle my care and would like to meet with their providers. They immediately went to work putting me in contact with a coordinator and getting me an appointment with the multi-disciplinary clinic that took place on Wednesdays. I was going to be able to meet with multiple oncology providers that specialized in breast cancer with young women and I would be able to do it all in one day. Finding out that I could do this all in one day was a huge relief, it meant a lot less appointments to plan for and they were able to get me in soon so I wouldn’t have to wait. My appointment was set for Wednesday January 11th and I was told to plan to be there from about 9am until maybe 6pm, it would be a long day and I would be getting a lot of information. I was going to be meeting with a genetic counselor, an oncologist, a surgical oncologist, a plastic surgeon, a radiation oncologist, possibly a social worker and I would likely be getting blood drawn that day too to get my base levels. In between January 6th and January 11th they transferred all my records and specimens from the previous hospital I was at to UCH and re-processed the specimens to confirm that the diagnosis was correct and to also determine what stage I was at. To my surprise, they also presented my case at a tumor board the morning before my case was unusual. To those that may not know,a tumor board normally includes providers from a variety of specialties and they gather together in one big room to go over difficult cases and discuss a variety of topics. Sometimes they discuss why the diagnosis is happening, how it happened, what possible treatments are, should others be involved that aren’t, etc. For me, the reason I was presented was that my case didn’t make sense to a lot of the providers that had looked at my case. I was a young woman, with no history of breast cancer, it was quite a large mass that I found myself and it had already spread to my lymph node. They wanted to be sure that they had the best treatment plan recommendations to provide me with the best prognosis for my future.
The days to get from January 6th to January 11th were the longest five days of our lives. We just wanted to get to the appointment and find out what our plan was and begin the process; we were very anxious as well as nervous. The day finally came, I got up early and headed in to begin the day to get my blood drawn and take an extra ultra sound of my breast as a double checking measure to make sure there weren’t other masses we needed to biopsy. Since it was so early that I needed these things done I decided to head to the hospital myself and let Nick and our special guest who flew in to be with us, arrive around 9am so that they could get a little more sleep before our day began. I won’t draw out all the details of each appointment but they sat us in a room and one by one each provider came in, explained who they were and what their plan was for me. It was this day that we learned I was between stage 2 and stage 3 of the cancer. The reason it was at least stage 2 was because it had crossed into my lymph node and the reason why it was almost stage 3 was also because of the lymph node involvement and because the size of my mass was quite large for the location; it was around 5cm. We also learned that I was a triple positive breast cancer patient, which means that my type of cancer reacts to estrogen, progesterone and HER2. These are types of receptors that live in my body and feed my cancer. A person can be triple negative too or they may also only have one or two of these receptors positive in their body for cancer.
After we had a recap of my situation and an explanation of my type of cancer and what it all meant we began to discuss the treatment options. I would be receiving 18 weeks of chemo which included six actual rounds of chemo, they consider it 18 weeks because you have to consider your recovery time between each set. During my chemo treatments I would be receiving a total of four drugs that would be administered through a port that would be surgically placed into my chest. Two of the drugs were chemo drugs (Taxotere and Cytoxen) and the other two drugs (Herceptin and Projeta) were drugs that would target my HER2 receptor. As a side note, the Herceptin is also something that I have to receive for an entire full year but thankfully it has very few and really not noticeable side effects. During chemo I would also be receiving an on body injector that would be applied after each chemo treatment to my arm to help boost my white blood cells. During chemo your white blood cell count can lower significantly so a product called Neulasta is given to help boost the cells, but does have it’s own side effects as well. Not every breast cancer patient starts with chemo as their treatment plan, but for me they wanted to be as aggressive as possible and the goal for chemo being first was for it to shrink as much of the cancer as we could; and of course prevent it from spreading any further.
After chemo I would then have about a five to six week break to recover a little bit from the chemo effects and then we would have surgery. I had a few options for surgery, I could choose a lumpectomy to just remove the parts that had cancer that might be left after chemo, a single mastectomy for only my left side or a double mastectomy to remove all tissue and lymph node(s). From the beginning I already knew what I was going to choose, double mastectomy, take it all. I wanted to make sure that I used all options possible to reduce my chances of re-occurrence. This decision meant that they would go in to remove any remaining cancer (if there was any), remove the lymph node that had the cancer (and possibly a few more) and all my other breast tissue from the right and left breast. Part of the surgery options was choosing if I wanted reconstruction for new breasts, and I definitely did. I could choose to have a tummy tuck and use my own fat/tissue to reshape my breasts or I could choose to have implants. I chose implants, I felt it was the best option for me and it would mean a smaller recovery timeline for me. The decision for implants meant that during surgery they would place expanders (basically deflated implants but harder) into breast cavities so that after surgery I could prepare my skin for implants.
Since we wanted to come at my cancer aggressively the surgery would not be my last stop, I would also be getting radiation. In our initial meeting in January it was decided that I would likely be getting six weeks of radiation, daily Monday thru Friday, to attack any potential microscopic cancer cells that may be living in my skin. The radiation would also be taking place about six weeks after my surgery so I could heal from that and expand my left breast enough away from my muscle so that the radiation could be as effective as it needed to be and where it needed to be. We wouldn’t be expanding my right side until after radiation was completed; and then I would need another three to six months to heal from radiation before I could receive my implants.
For the most part that was our full treatment plan, it would be a little over a full year before we were “done” with main fight against breast cancer. Some of the items that added to our year fight was the full year of Herceptin I would be needing, reconstructive surgery and the fact that I would need to be taking a pill that was basically oral chemo (with way less of the side effects) for the next five years to also help reduce chance of re-occurrence. Through the year there would also be the multitude of appointments that I would be receiving for blood draws, bone scans (bone density/loss was an additional side effects of the drugs I would be receiving) and echo scans of my heart to make sure my heart muscles weren’t weakening (side effect of the Herceptin).
It would be a long year but we were ready, there were also some plans that we had that would need to change but that was okay, my health was first priority. We knew that it would be a tough year, but we also knew that we would be learning a lot about life and about each other. It was a journey and I had my pink boxing gloves on from day 1, I was fighting this no matter what and outside of the drugs I would be fighting it with humor, sarcasm and positivity. Now… if you want to get into the details that dealt with more of the emotions we went through head on over to the other entry that says (gray version).